Sunday, June 18, 2017

One Year in the Black


It has been just over one year since I reached a net worth of zero.  After being in debt for almost ten years, it has been a welcome change to open the Excel file in which I track everything financial and see that my investments finally exceed the balance on my line of credit.

As a medical student and resident, I hadn't thought much about finances.  I was surrounded by people who came from wealthy families, and it didn't take me long to adopt their spendy habits and to accumulate a lot of debt.  I reassured myself that "everyone was doing it" and that the debt was okay, because it would be easily repayed once I became a physician and started getting paid in bags full of money.  I rarely looked at the balance of my line of credit, and whenever I did it was just a quick glance, followed by a nervous chuckle at the ridiculousness of owing the bank such an enormous sum.

It wasn't until my last year of fellowship that I actually woke up to the reality of how much money I owed and started doing something about it.  I went on a budget, and I actually started spending less than I was earning for the first time in eight years.  I didn't save a lot of money in that year, as it was a major adjustment just to start living within my means, but at the very least I laid some groundwork for financial responsibility as an attending.

And then I finished training!  And got an adult job!  And suddenly there was a lot of extra money to put towards savings and debt repayment.  Every day that I worked, I got a little bit closer to the longed for balance of zero.  And yet, my anxiety about money actually got worse.  When my line of credit was ridiculously big, I comforted myself by saying that I could declare bankruptcy if I ever lost my job*, because there was no way I could pay it back on anything other than a physician's salary.  As it got smaller, and my investments bigger, I suddenly entered territory where I would be expected to pay back my loans, regardless of whether I could continue to work as a physician.  And the idea of earning a non-physicians salary but still being $50,000 or $60,000 in debt was terrifying.

Thankfully, I have kept my job, and after ten months of working and saving I got myself back into the black.  I expected that the anxiety about money would resolve instantaneously after achieving that milestone, but oddly enough I didn't take a lot of comfort in being a 39-year old with a net worth of zero.  I still felt vulnerable to the possibility of becoming disabled** or burning out of my career and not having enough money to have good options.  So I kept saving and repaying debt and watching my net worth get healthier and healthier.

In the past year, I've increased my net worth by enough that I could live at my current standard of living for about three years.  While I hesitate to share actual numbers here, I will say that my net work growth breaks down roughly as follows:  10% from growth on investments; 10% line of credit repayment; 30% cash savings (for a down payment on our first home); and 50% long-term savings (RRSPs and a TFSA to minimize taxes). 

My savings vary a lot from month to month, due to a fluctuating call schedule and taking time off work for vacations and conferences, but the overall trajectory of my net worth has been pleasantly positive.  And finally...FINALLY...I am starting to relax a little.  It is comforting to know that I could become disabled and live comfortably off my disability insurance payments.  Or I could burn out from medicine and pursue a different career, and I would be absolutely fine.  For the first time in a decade, I feel like I have some real security and real options.  I'm still a long way from financial independence, but at least I'm sleeping more peacefully at night.

*I only had private student loans, so I think they would have been cancelled out by a bankruptcy.  But don't quote me on that.  And don't be an idiot like me and think that bankruptcy is a good financial strategy!

**Yes, I have disability insurance.  As should every physician.

Sunday, June 11, 2017

Retiring To, Instead of From

One of the nurses I work with in my inner city clinic retired last week.  I'm in a bit of denial about the whole situation, as she takes with her over thirty years of relationships with patients and experience in the community, and it is going to be a terrible, horrible adjustment to run the clinic without her.  It's a bit like a body trying to function after a left main occlusion has knocked out most of the heart.  Still possible (hopefully), but irreversibly impaired.

I've known that her retirement was coming for most of this year, so there has been plenty of opportunity to prepare for the transition and to hire a replacement.  Fortunately, we've managed to poach a really excellent and experienced nurse from another physician who practices in the same field (sorry colleague!), so the new nurse will be about as good as possible for a replacement.  I've also had some time to mentally prepare myself for the change, although I haven't done as much as I probably should have (see above statement re: "bit of denial").

Interestingly, from talking with the nurse who is leaving, it doesn't seem that she's done that much mental preparation for her retirement either.  She seems to be very financially prepared - house paid off, full defined pension from over 30 years of service, personal savings beyond the pension - but she seems to have very little idea of what she's going to do with herself after working her last shift.  When asked about her plans, she will say "Well....I have a lot of sewing I'd like to do".

She's not even 60!  And she's been working full-time in a busy, stressful, and emotionally challenging medical practice.  How does one transition from that to a life of doing "a lot of sewing"? 

I worry about her, a little bit, at the same time as I am insanely jealous of anyone who has managed to permanently free herself from the need for full-time employment.  I wonder if this incredible opportunity she has to explore new interests and do anything she wants to is going to feel like a disappointment, because she hasn't taken the time to figure out what she wants to be when she grows up. 

If I continue at my current savings rate, and there are no major economic collapses in the near future, then I'm on track to be able to retire in about nine years.  And while I try not to focus on retirement and to live in the present moment as much as possible, you can bet there is part of me that is always dreaming about what I will be able to do in the post-employement stage of life.  There will, of course, be many books to read, and as many places to travel as we can afford.  But there will also be volunteer work, and community involvement, and learning to speak a second language, and writing, and so many other things.  I will probably be busier in retirement than I am in my working life, because I will be able to choose to do whatever excites me most instead of doing things I don't love out of necessity.  (Hint:  It will not include dictating clinic letters.)

When I retire, it won't be just because I've saved up enough money and that's what people do as soon as they can afford to.  It will be because whatever I have planned next is even better than the crazy but wonderful world of medicine.

---
On a completely unrelated note, if you like cats at all, then you should really find a way to see the documentary Kedi, which is about the street cats of Istanbul.  It is beautiful and touching and funny and filled with cats, which makes anything in life better.  M and I saw it yesterday, and even she, the intransigent dog lover, thought it was worth watching.


Tuesday, June 6, 2017

How To Be Less Stabby While On Call

As a resident, I couldn't wait for the day that I would be an attending and would get to do fewer call shifts.  In my last two years of residency, I did 130 days of call per year, while as an attending I do about 70 days per year.  I anticipated that my attending schedule would feel positively luxurious by comparison, but of course, as with many things in life, that hasn't been the case.  Somehow doing less call makes me less accustomed to it and even more resentful of it when I'm in the midst of it.

Generally, I spend my weeks on call in a self-indulgent funk.  I whine about how busy I am and how long the days are; I neglect anything that isn't work-related (thank all that is holy for housekeepers); and I live off of all the foods that I tell my patients to never eat.  I'm about as miserable and self-pitying as an adult can acceptably be.  Possibly more so.
This call period, however, things seem to have shifted, if only the slightest bit.  I hate my life a little less than normal.  My smiles for patients and co-workers are a little more sincere.  I spread a little less misery everywhere I go.

Being caught up on everything at the start of the call period has probably been the biggest contributor to my slightly less horrible than usual mood.  My state of being on top of things lasted for all of one day after I started call, but at the very least I've only had to scramble to keep up with the additional work of call*, rather than struggling not to drown under call work and leftover work from the weeks before.  There is comfort in knowing that, at the absolute worst, I'm no more than two weeks behind on things.

The slight reduction in overwhelm at work has carried over into not feeling like I want to die when I get home, which in turn has led to me actually doing productive things in the evening.  Where normally I would binge watch Gilmore Girls with a peanut butter chocolate Drumstick** in my hand, I've actually gone for walks to enjoy the beautiful Spring weather.  I've done dishes.  I've paid bills.  I'm actually adulting!

http://hyperboleandahalf.blogspot.ca/2010/06/this-is-why-ill-never-be-adult.html
Maybe forty will be the year that I actually grow up?

*Unsuccessfully, of course.

**Immediately after writing this I ate a peanut butter chocolate Drumstick.  Because I'm only human.  I would've turned on Gilmore Girls, but the girlfriend isn't home, and I think watching our show without her is probably grounds for divorce.

Thursday, May 25, 2017

Parkinson's Law

Subtitle:  Work expands so as to fill the time available for its completion

Just over a year ago, I wrote smugly about how I had gotten caught up on all of my tasks at work and about how wonderful it felt.  At the time, I fully intended to keep up with everything, always and forever, so as to keep the wonderful feeling going.

I think I may have lasted a month.

Inevitably, I got behind during a busy time at work, and then I never seemed to have enough time or motivation to get caught up again.  So for most of the past year, I've left work every day knowing that there were piles of charts and long to-do lists waiting for me the next morning.

For me, the worst part about never being caught up isn't the overwhelming feeling of always having too much to do:  it's the terrible lethargy that comes from doing the same thing over and over again without seeing any progress.  There is nothing quite as demotivating as signing off on a letter, only to be greeted by 50 other letters that need signing off.  For the past year, work has felt like a neverending slog through the same neverending tasks.  Day after day after day.

A few weeks ago, I had a brief but welcome break from the teaching and presenting and administrative duties that fill my non-clinical time.  And I thought to myself "Now!  Now is the time to get caught up again."  So I took the extra time I had and phoned every last patient and dictated every letter and signed off on every chart.  For the first time in way too long, I was caught up.

And I've stayed that way for the past three weeks.  And once again, it has felt amazing.  I feel a little burst of joy every time I open my letter queue and see the words "You have no new letters to sign off".  Or when I look at my empty inbox.  Or when I look at the folders in my desk, and there's absolutely nothing in them.

The second best part of being caught up is that I've regained the efficiency that I had lost.  When I have just a few tasks to do, I can plow through them quickly, knowing that I'm going to get the satisfaction of being done, once again.  And it's much easier to let go of my relentless perfectionism when I know that it's standing between me and being caught up on everything.

The absolute best part?  I get a bonus day off today because I'm done everything!  I was finishing up my tasks yesterday, and I realized that there wasn't anything that needed to be done today, so I didn't have to come in for my usual catch up day in the office.  No dreaded Thursday paperwork day.  I've taken my car in to get the winter tires removed (just a wee bit late), gotten a haircut for the first time in eight months, and now written a blog post.  Next is lunch and then reading for fun.

https://en.wikipedia.org/wiki/Life_After_Life_(novel)

Life, for this moment at least, is good.

(If you are hating me and my smugness right now, please note two things:  1)  I start two weeks of call on Monday, which is going to destroy everything I just wrote about; and 2) When I say I'm "done everything", I am ignoring the paper I need to write and the CV I need to update and a number of other longer-term tasks that will forever be on my to-do list.  No matter how efficiently I work or how late I stay, there will always be something left to do.)

Thursday, May 11, 2017

The End of the Thirties

When I was a few months into dating my girlfriend, we celebrated her birthday together for the first time.  For me, birthdays have always a pretty understated affair, marked by a single special dinner and maybe a cake.  Not so for my girlfriend.  For her, birthdays are an event...or more accurately multiple events involving as many different activities and as many people as possible.  I was somewhat stunned that first year by the number of celebrations that a single person could have in honour of her birthday.

It took me a few years to realize that this was something that I could use to my advantage, but now that I'm three years into the relationship and a few days away from my fortieth birthday, I know to milk it for all it's worth.  I'm not having a single birthday this year; I'm having a birthday month.  Dinner with friends, dinner with both sides of the family, an Escape Room with other friends*, and birthday tapas with the girlfriend.  I will be celebrated!

And, inevitably, I will be a bit melancholy.  Because there is something about turning forty that feels...old.  Forty marks the end of the decade in which I went through medical school, residency, and fellowship.  It marks the end of the decade in which my father died.  It appears to mark the end of my single life and of dating new people**.  Realistically, it probably marks the end of any chance that I will have a biological child.  While I am hopeful for good things in the upcoming decade, I can't help but feel a bit wistful for the things being left in my thirties.

How does one let go of so many things that made them who they are?

*Have you ever done an Escape Room?  Puzzles and friendly competition all in one?  Yes!  Love them.

**If my girlfriend reads this, which she only seems to do when I write something she would find remotely bothersome, I can just hear her saying "Appears to?  What does 'appears to' mean???"

Saturday, April 1, 2017

Mistakes, I've Made A Few

When I started medical school, I believed wholeheartedly that physicians were perfect.  I fully expected that, over the following 6-9 years of training, I would fill my brain with everything I needed to know about medicine and that I would learn how to use this information correctly, in every patient encounter, with 100% accuracy.

I'm not sure where I got this idea from.  Certainly I recognized (probably too clearly) that I was a fallible human being, yet I somehow thought that medical training would beat the fallibility out of me.  I envisioned the epic 28-hour-plus call shifts transforming me into someone perfect, someone who never wrote down the wrong drug dose and who never froze, uncertain of what to do, in the middle of a code blue.

It was a shock to me then, as I progressed through my training, to discover that my human imperfections didn't go away.  I certainly learned to be much better - to double check my orders and to write list after list in an attempt to never miss anything - but the promise of perfection has remained elusive.  Sometimes I slip up.  Sometimes I forget to do something important, or I fail to take something into consideration when making a treatment plan, or I misjudge just how sick the patient in front of me is.

Imperfection feels horrible as a trainee, but it still feels bearable.  As a trainee, right up until the last day of fellowship, there is always someone watching, someone double checking.  Someone who ranks higher than you on the list of people responsible.  Someone who retains the burden of final responsibility.

And then you graduate.  And now you are the person in charge.  And suddenly the weight of the work you do, the importance of every decision you make, seems ten times greater.  Double checking becomes triple checking.  Minutes of insomnia turn into hours.  Precious time outside of work, which is finally not quite as rare as it was in training, is spoiled by endless questioning and self doubt.

Did I screw something up?

Is someone going to die because of something I did?

And the worst part of it is, almost no one talks about it.  If you ever dare to talk to a colleague about your fears, they will minimize them, reassuring you that you're one of the good doctors.  You're not one of the ones who makes mistakes.

Almost no one acknowledges that we all make mistakes.  And that it isn't enough to learn how not to make mistakes or, more realistically, how to make fewer of them. What we really need to learn is how to cope with the fact that we are fallible humans, called upon to do superhuman work despite our inability to ever be superhuman.

Monday, February 20, 2017

Usted Esta Aqui


M and I just came back from a lovely week in Cuba.  It had been seven months since my last true vacation (a week off at home for our local theatre festival in July), and I was starting to crack a bit under the strain of constantly having to be on for other people.  A week of sun and books and more alcohol than is recommended was somewhat desperately needed.


The setup was perfect for relaxing.  We were in an all-inclusive resort, so the most strenuous thing required of us was walking from our table to the buffet to refill our overflowing plates.  And yet, despite being on vacation, I found it hard to turn off the constant chatter in my brain.  When eating, I would be thinking about the books that were waiting to be read; when reading, I'd be wondering what was going to be served at our next meal.   When on the beach, I'd be wondering if I would've been happier spending the day in Havana; when in Havana, I would dream about the beach. 


My distractible brain, my ever present companion at home, had followed me to paradise*.


I am so accustomed to my constant thoughts about what else I should be doing and what needs to be done next that it took me days to recognize how ridiculous they were in paradise.  My moment of clarity happened on the beach, when M was snorkeling in the shallow water and I was walking beside her.  I had just come out of the water myself, and I was feeling a bit chilled, and all I could think about was wanting the walk to be over so that I would be back at my beach chair and wrapped in a warm towel.


And then I paused.  And I thought "Why on Earth am I wishing this time away?"  Wanting to be back at the beach chair wasn't going to make the distance any shorter or make M swim any faster.  All it was going to do was rob a perfectly good moment of any potential for happiness.  So I stopped, and instead of feeling my usual impatience, I took a look around me.  At the people and the palm trees and the mountains all glowing in the warmth of the late day sun.  And I realized that I was literally in the middle of a postcard.


A postcard that I had almost missed, because all I know how to do anymore is rush from what I am doing to whatever it is that comes next.

*I recognize that I am very privileged to view Cuba as "paradise", as that isn't the experience for many of its citizens.